Croagh Daniel Gerald, Devonshire David, Poh Benjamin, Berry Roger, Bowers Kaye, Spilias Dean, Cullinan Mark, Cashin Paul
Department of Surgery, Monash Medical Centre, Clayton, Victoria, Australia.
ANZ J Surg. 2015 Jan;85(1-2):53-7. doi: 10.1111/ans.12341. Epub 2013 Aug 1.
Laparoscopic bile duct exploration at the time of laparoscopic cholecystectomy has been promoted as being equally successful as endoscopic bile duct clearance. Further, if successful it offers the possibility of reducing the number of interventions required and therefore reducing overall costs. However, there is little in the literature that describe current treatment patterns in the Australian environment.
Medicare data were obtained for the number of patients undergoing laparoscopic cholecystectomy, intraoperative cholangiography, laparoscopic transcystic bile duct exploration, laparoscopic choledochotomy and bile duct exploration, endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy and endoscopic biliary stent insertion.
Although there was significant state-to-state variation in the prevalence of laparoscopic bile duct exploration (0.6-3.7%), ERCP remained the predominant method of bile duct clearance in the setting of laparoscopic cholecystectomy (5.4%). Transcystic bile duct exploration is far more common than laparoscopic choledochotomy, which is a rare procedure. This suggests that patients with a dilated common bile duct and large or multiple stones are typically undergoing ERCP rather than laparoscopic bile duct clearance.
Despite the apparent attractiveness of laparoscopic bile duct exploration at the time of cholecystectomy, ERCP remains the most common method of dealing with choledocholithiasis in the setting of an intact gallbladder in Australia.
腹腔镜胆囊切除术时进行腹腔镜胆管探查术已被推广，其成功率与内镜胆管清理术相当。此外，如果手术成功，它有可能减少所需的干预次数，从而降低总体成本。然而，文献中几乎没有描述澳大利亚环境下当前的治疗模式。
获取医疗保险数据，内容包括接受腹腔镜胆囊切除术、术中胆管造影、腹腔镜经胆囊管胆管探查术、腹腔镜胆总管切开术和胆管探查术、内镜逆行胰胆管造影（ERCP）、括约肌切开术和内镜胆管支架置入术的患者数量。
尽管腹腔镜胆管探查术的患病率在各州之间存在显著差异（0.6 - 3.7%），但在腹腔镜胆囊切除术的情况下，ERCP仍然是胆管清理的主要方法（5.4%）。经胆囊管胆管探查术远比腹腔镜胆总管切开术常见，后者是一种罕见的手术。这表明胆总管扩张且结石大或为多发的患者通常接受ERCP而非腹腔镜胆管清理术。
尽管胆囊切除术时进行腹腔镜胆管探查术具有明显的吸引力，但在澳大利亚，对于胆囊完整的情况下处理胆总管结石，ERCP仍然是最常见的方法。
